A Multi-Method Assessment of Satisfaction with Services in the Medical Home by Parents of Children and Youth with Special Health Care Needs (CYSHCN)

Unmet Needs of Male Caregivers of Children and Youth with Special Health Care Needs

OBJECTIVES

The caregiving experiences and unique health needs of male caregivers of children and youth with special health care needs (CYSHCN) are not well described. This study seeks to understand potential unmet health needs and attitudes toward supportive resources from the perspective of a sample of male caregivers of CYSHCN.

METHODS

This mixed-methods study recruited a convenience sample of 30 men with CYSHCN who receive care for a chronic medical condition from primary care medical homes in Pennsylvania. We conducted semi-structured interviews (SSI), administered quantitative surveys to caregivers, and produced a thematic analysis. The SSI explored the health needs of male caregivers, assessed attitudes toward and preferences regarding supportive resources, and garnered their advice to other caregivers regarding parenting and health care system navigation.

RESULTS

Participants' median age is 41 years (IQR: 33, 44), and most (80%) reside full time with their CYSHCN. Most male caregivers deprioritized their own emotional, mental, and physical health needs to support the needs of their families. Many male caregivers articulated interest in seeking emotionally supportive resources (not time-intensive). They advised other male caregivers to remain involved in the medical care and wellbeing of their CYSCHN and to openly seek and receive emotional support despite the daily challenges they face.

CONCLUSIONS FOR PRACTICE

Male caregivers of CYSHCN experience intense daily stress and express the need for emotionally supportive resources. Programs designed to facilitate such support may benefit from flexible formats (time and location) and involve male caregivers of CYSHCN as both facilitators and participants.

Physician Assistant Students' Competency to Identify and Diagnose Autism Spectrum Disorder

PURPOSE

Autism spectrum disorder (ASD) is a neurodevelopmental condition characterized by deficits in communication and reciprocal social interactions. Little research has focused on the evaluation of developmental/behavioral pediatric education in the physician assistant (PA) curriculum. Therefore, the aims of this study were to evaluate whether PA students received training in identifying the red flags of ASD, using screening tests such as the Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F). Additionally, the study sought to determine if PA students received education on the evaluation and management of children with ASD along with the methods to communicate effectively with their caretakers.

METHODS

A survey open to PA students was administered by the American Academy of PAs. Demographic information along with questions on knowledge and perceptions related to ASD were asked. Perceptions of preparation to discuss ASD with patient caregivers were assessed, along with vaccination beliefs, and training information was collected.

RESULTS

A total of 213 PA students answered the survey. Students received training regarding the red flags for ASD as well as ASD-related skills. Of note, 58.2% did not receive training on administration of the M-CHAT-(R/F) and 54.9% did not receive training to provide care to patients with ASD; 77.8% received training to understand pediatric developmental milestones. PA students overwhelmingly rejected the suggestion that there is a link between vaccines and ASD.

CONCLUSION

The importance of diagnosing ASD as early as possible has been demonstrated by years of research; yet, this study concludes that many students still do not feel comfortable recognizing the red flags or using screening tools. Although the majority of PA students received training to understand developmental milestones, many did not know how to administer the M-CHAT-(R/F), which is key to making an early diagnosis.

Impact of Child Psychiatry Access Programs on Mental Health Care in Pediatric Primary Care: Measuring the Parent Experience

OBJECTIVE

This study aimed to assess parents' satisfaction with the primary care provider (PCP) in the treatment of their child's mental health problems after the PCP consulted with the Massachusetts Child Psychiatry Access Program (MCPAP). It studied how parental satisfaction may vary across factors, including service utilization, parental perception of the child's illness, and parental perception of certain PCP attributes.

METHODS

The study analyzed 374 telephone consultations made from PCPs to MCPAP between March 2010 and June 2012. Questions in a structured telephone survey administered to parents identified the types of services participants were referred to and assessed satisfaction rates on the basis of measures reflective of the patient-doctor relationship and of illness factors.

RESULTS

Eighty-six percent of participants expressed satisfaction with their PCP's handling of their child's mental health problems after MCPAP consultation. Participants who agreed with statements reflective of a positive patient-doctor relationship (in terms of the PCP's empathy and knowledge) exhibited higher rates of satisfaction with the PCP's role in the treatment of their child's mental health problems than those who did not agree. The most common recommendations made to families after consultation were to follow up with the child's PCP (94%) and to obtain further MCPAP consultation (78%).

CONCLUSIONS

The survey results indicated high rates of parents' satisfaction with the PCP's handling of their child's mental health issues. Recommendations made to PCPs by MCPAP consultants aimed to strengthen the PCP's role as a mental health provider.

Determinants of satisfaction with motor rehabilitation in people with cerebral palsy: A national survey in France (ESPaCe)

BACKGROUND

User satisfaction is a key indicator of healthcare quality.

OBJECTIVE

We aimed to identify factors associated with satisfaction with motor rehabilitation (MR) in children and adults with cerebral palsy at a national level, using determinants related to patient characteristics, healthcare organisation and practice features.

METHODS

This study was part of ESPaCe, a national survey aimed at documenting the views of individuals with cerebral palsy and their families regarding MR services via a questionnaire, developed by a multidisciplinary group. The ESPaCe questionnaire included the Client Satisfaction Questionnaire (CSQ-8), whose total score was the primary outcome of this study. Survey participation was promoted nation-wide. The questionnaire could be completed by the person with cerebral palsy or their main carer. Analysis included the description of determinants across CSQ-8 quartiles and generalised linear modelling of the CSQ-8 score.

RESULTS

From June 2016 to June 2017, 1010 eligible participants (354 children, 145 adolescents and 511 adults) responded to the questionnaire, and 750 completed the CSQ-8. Univariate analysis suggested that multiple factors affected satisfaction with MR. On multivariate sequential adjustment, the factors that decreased satisfaction (all P<0.001) were being an adolescent, Gross Motor Function Classification System levels IV/V, frequent pain, receiving physiotherapy in private practice and poor access to a physiotherapist with specific CP training. Factors that increased satisfaction (all P<0.001) were presence of an MR coordinator, exchanges between healthcare professionals, provision of information regarding MR organisation, and goal setting and effective pain management by the physiotherapist. Organisation and practice features improved the predictive ability of patient characteristics (R²=0.40).

CONCLUSION

This study suggests that measures to improve the quality of healthcare for individuals with cerebral palsy should focus on improving pain management by the physiotherapist, establishing a therapeutic alliance, and greater provision of CP-specific practice education for healthcare professionals.

Factors associated with parents' levels of stress in pediatric wards

Hospitalization of a child is a stressful experience, increasing parents' anxiety and deteriorating their satisfaction with the health-care services. This study aimed to assess the level of stress that parents of hospitalized children experienced and evaluate the association of parent's stress and satisfaction and identify its predictors. Three hundred and fifty-two parents whose children were hospitalized in two pediatric hospitals were enrolled in the study, from February 2015 to April 2015. The Perceived Stress Scale was used to estimate parental stress and the Pyramid Questionnaire was used for assessing parents' overall satisfaction with care. Parents expressed mild to moderate overall levels of stress. Less-stressed parents felt more satisfied. Being single ( p < .001), having lower educational level ( p = .005), one's child been hospitalized for more than 14 days ( p = .001), and one's have visited the hospital many times in the past ( p = .014) were the predictors of experiencing high levels of stress. During pediatric hospitalization, parental needs (communication, interpersonal health care, continuous information, involvement in child's care) should be considered, so as stress levels to be decreased and parents get more satisfied by the quality of health care provided.

Reducing the Number of Anesthetic Exposures in the Early Years of Life: Circumcision and Myringotomy as an Example

Evidence suggests multiple anesthetics in early childhood may increase risk for neurodevelopmental injury. We evaluated proportions of children undergoing circumcision and myringotomy, concomitantly with or prior to circumcision, and compared costs between groups. The Pediatric Health Information System was queried for males aged 6 to 36 months who underwent circumcision in 2009-2014. Relative to circumcision, the proportion who underwent myringotomy previously, concomitantly, or both, was calculated. Of 29  789 patients who underwent circumcision, 822 also underwent myringotomy; 342 (41.6%) underwent myringotomy on a previous day, and 480 (58.4%) underwent myringotomy at time of circumcision. Total hospital costs were lower for concomitant procedures (median $2994 vs $4609, P < .001. In total, 58.4% of patients who underwent circumcision and myringotomy did so concomitantly. Combined procedures resulted in significantly reduced costs and potentially minimized neurocognitive risk. Ideally, both referring pediatricians and surgical specialists should inquire about other surgical needs to optimize the availability of concomitant procedures.

The participation of parents of disabled children and young people in health and social care decisions

BACKGROUND

There is widespread acceptance that parents should be fully involved in decisions about their son or daughter's health and social care. This is reflected in partnership models of practice as well as local and national policy across the United Kingdom. Previous research indicates that parents' experiences of decision making with professionals are mixed.

AIM

The research reported here aimed to explore parents' experiences of participating in decisions made with professionals about their disabled son or daughter's care.

DESIGN

This research used mixed methods including survey methodology and qualitative in depth interviews.

SETTING AND PARTICIPANTS

The research was conducted in one Trust in Northern Ireland. Participants were 77 parents of children and young people with a range of impairments aged between 3 and 28 years.

RESULTS

Three themes emerged from the data: taking the lead, not knowing, and getting the balance right. Parents wanted to be involved in all aspects of decision making. Although parents reported many examples of good practice, there were also times when they did not feel listened to or did not have enough information to inform decisions.

DISCUSSION AND CONCLUSION

Parents in this research recounted positive as well as negative experiences. Parents took on a protective role when decisions were made about their son or daughter and at times, reported the need to "fight" for their child. The provision of information remains problematic for these families, and at times, this created a barrier to parents' participation in decision making. Partnership approaches to care that recognize parents' expertise are particularly important to parents when decisions are made with professionals.

Children with medical complexity: a scoping review of interventions to support caregiver stress

BACKGROUND

Caring for children with chronic and complex medical needs places extraordinary stress on parents and other family members. A scoping review was undertaken to identify and describe the full range of current interventions for reducing caregiver stress.

METHODS

Applying a broad definition of caregiver stress, a systematic search of three scientific databases (CINAHL, Embase and Ovid Medline), a general internet search and hand searching of key peer-reviewed articles were conducted. Inclusion criteria were as follows: (i) published in English between 2004-2016; (ii) focused on familial caregivers, defined as parents, siblings or extended family; (iii) targeted children/youth with medical complexity between the ages of 1-24 years; and (iv) described an intervention and impact on caregiver stress. Data on type of intervention, study design and methods, measures and overall findings were extracted.

RESULTS

Forty-nine studies were included from a list of 22 339 unique titles. Six domains of interventions were found: care coordination models (n = 23); respite care (n = 8); telemedicine (n = 5); peer and emotional support (n = 6); insurance and employment benefits (n = 4); and health and related supports (n = 3). Across studies, there was a wide variety of designs, outcomes and measures used.

CONCLUSIONS

Positive findings of reductions in caregiver stress were noted within an emerging body of evidence on effective interventions for families of children with medical complexity. A commonality across domains was a significant focus on streamlining services and reducing the burden of care related to varied pressures experienced, including time, finances, care needs and service access, among others. There was non-conclusive evidence however around which of the six identified intervention domains or combination thereof are most effective for reducing stress. These promising findings demonstrate that stress reduction is possible with the right support and that multiple interventions may be effective in reducing burdens of care experienced by families of children with medical complexity.

Long-term pediatrician outcomes of a parent led curriculum in developmental disabilities

Previous research has demonstrated high satisfaction and perceived relevance of Project DOCC (Delivery of Chronic Care), a parent led curriculum in developmental disabilities, across a sample of medical residents.

AIMS

The influence of such a training program on the clinical practices and professional activities of these residents once they are established in their careers as physicians, however, has not been studied; this was the aim of the present study.

METHODS

An anonymous follow-up survey was designed and disseminated to physicians who participated in Project DOCC during their one-month developmental disabilities rotation as part of their pediatrics or medicine/pediatric residency between 2002 and 2010. Fifty-eight physicians completed the survey.

RESULTS

The findings suggest that participation in a parent led curriculum during medical residency had a lasting impact on physicians' relationships with families. Specifically, a majority of the physicians espoused a family-centered approach to care, a sensitivity to the interactional effect that caring for a Child with Special Health Care Needs (CSHCN) has on family members, the need for physicians to have a prominent role in community resource coordination, and the importance of an integrated approach to health care provision.

CONCLUSIONS

Use of a parent led curriculum as a means to increase the provision of family-centered care by physicians is supported.

The Role of Care Coordinator for Children with Complex Care Needs: A Systematic Review

Introduction:

This systematic review seeks to identify the intended components of the role of care coordinator for children with complex care needs and the factors that determine its composition in practice.

Theory and methods:

The initial search identified 1,157 articles, of which 37 met the inclusion criteria. They were quality assessed using the SIGN hierarchy of evidence structure.

Results:

Core components of the role include: coordination of care needs, planning and assessment, specialist support, emotional support, administration and logistics and continuing professional development. Influencing factors on the role include the external environment (political and socio-economic), the internal environment (organisational structure and funding protocols), the skills, qualifications and experience of the coordinator, the family circumstances and the nature of the interaction between the care coordinator and the family.

Discussion:

The lack of consistent terminology creates challenges and there is a need for greater consensus on this issue. Organisations and healthcare professionals need to recognise the extent to which contextual factors influence the role of a care coordinator in practice and plan accordingly. Despite evidence that suggests that the role is pivotal in ensuring that care needs are sustained, there remains great variability in the understanding of the role of a care coordinator for this population.

Conclusions:

As the provision of care increasingly moves closer to home there is a need for greater understanding of the nature and composition of the interaction between care coordinators and families to determine the extent to which appropriate services are being provided. Further work in this area should take into consideration any potential variance in service provision, for example any potential inequity arising due to geographic location. It is also imperative, where appropriate, to seek the views of children with complex care needs and their siblings about their experiences.

Important knowledge for parents of children with heart disease: parent, nurse, and physician views

OBJECTIVES

Parental understanding of their children's heart disease is inadequate, which may contribute to poor health outcomes. The purpose of this study was to determine what parental knowledge is important in the care of children with heart disease from the perspective of parents, nurses, and physicians.

METHODS

Focus groups were formed with parents of children with single ventricle congenital heart disease (CHD), biventricular CHD, and heart transplantation, and with nurses and physicians who provide care for these children. A nominal group technique was used to identify and prioritise important parental knowledge items and themes. The voting data for each theme were reported by participant type--parent, nurse, and physician--and patient diagnosis--single ventricle CHD, biventricular CHD, and heart transplantation.

RESULTS

The following three themes were identified as important by all groups: recognition of and response to clinical deterioration, medications, and prognosis and plan. Additional themes that were unique to specific groups included the following: medical team members and interactions (parents), tests and labs (parents), neurodevelopmental outcomes and interventions (physicians), lifelong disease requiring lifelong follow-up (physicians and nurses), and diagnosis, physiology, and interventions (single ventricle and biventricular CHD).

CONCLUSIONS

Parents, nurses, and physicians have both common and unique views regarding what parents should know to effectively care for their children with single ventricle CHD, biventricular CHD, or heart transplantation. Specific targeted parental education that incorporates these findings should be provided to each group. Further development of questionnaires regarding parental knowledge with appropriate content validity is warranted.

Understanding utilization of outpatient clinics for children with special health care needs in southern Israel

To understand the pattern of utilization of ambulatory care by parents of children with special health care needs (CSHCN) and to explore parental challenges in coping with health maintenance of their infants after discharge from a neonatal intensive care unit (NICU). CSHCN require frequent utilization of outpatient ambulatory clinics especially in their first years of life. Multiple barriers are faced by families in disadvantaged populations which might affect adherence to medical referrals. Our study attempts to go beyond quantitative assessment of adherence rates, and capture the influence of parental agency as a critical factor ensuring optimal utilization of healthcare for CSHCN. A prospective, mixed-methods, cohort study followed 158 Jewish and Bedouin-Arab infants in the first year post discharge from NICU in southern Israel. Rates of utilization of ambulatory clinics were obtained from medical records, and quantitative assessment of factors affecting it was based on structured interviews with parents at baseline. Qualitative analysis was based on home visits or telephone in-depth interviews conducted about 1 year post-discharge, to obtain a rich, multilayered, experiential perspectives and explained perceptions by parents. Adherence to post-discharge referrals was generally good, but environmental, cultural, and financial obstacles to healthcare, magnified by communication barriers, forced parents with limited resources to make difficult choices affecting utilization of healthcare services. Improving concordance between primary caregivers and health care providers is crucial, and further development of supportive healthcare for CSHCN in concordance with parental limitations and preferences is needed.

Evaluation of family-centred services from parents of Chinese children with cerebral palsy with the Measure of Processes of Care

BACKGROUND

Family-centred service (FCS) has become essential to parents of children with cerebral palsy (CP) and professionals in Chinese paediatric rehabilitation services. FCS practice meets the unique needs of the child and family, through facilitation of optimal service provision delivered by professionals, and ensures service systems to be flexible, appropriate and actively responsive to the family needs. Parents used the Measure of Processes of Care 20 (MPOC-20) questionnaire to evaluate and verify the efficacy of use in China. The aims of the present study were twofold: to assess the validity and reliability of the Chinese MPOC-20, and investigate the range of parents' satisfaction with service provision in an FCS practice using the MPOC-20.

METHODS

The Chinese MPOC-20 was selected to assess parent satisfaction with service provision of professionals in FCS practice. Participants were parents of children under 8 years of age with CP, who had received rehabilitation services between May 2012 and May 2013, and were receiving rehabilitation services in May 2013 at a hospital outpatient department and a rehabilitation centre.

RESULTS

The reliability and validity of the Chinese MPOC-20 were confirmed. Parents evaluated FCS practice with the MPOC-20 survey. Respectful and supportive care was rated with the highest score and providing general information the lowest. Parents according to the data were dissatisfied with the lack of information.

CONCLUSIONS

Parents fairly evaluated service provision of professionals in FCS practice with the Chinese MPOC-20. Professionals received feedback reports of parents, summaries of the inadequacy of service delivery, and developed and implemented ameliorated measures in the FCS policy to strive to provide exemplary service.

[Factors related to dissatisfaction and anger in parents of children treated at paediatric emergency services]

AIM

Anger in patients and relatives is very frequent in health emergency services and is often associated with aggressiveness and emotional alterations. The aim of the present study is to explore anger in parents while their children are receiving care in paediatric emergency services, seeking the specific dimensions of dissatisfaction that may predict the onset of anger in parents.

MATERIALS AND METHODS

A cross-sectional descriptive study using a self-report questionnaire in 711 parents of children seen in paediatric emergency departments. The self-report questionnaires used were the State-Trait Anger Expression Inventory-2 (STAXI-2) and the Satisfaction with Healthcare Services Scale. The statistical analysis included descriptive, correlational, variance and multiple linear regression models.

RESULTS

A total of 53 parents (7,5%) showed a moderate or high anger level. The mean score for satisfaction was 37.12 (SD=7.33). It was found that higher levels of overall satisfaction were significantly associated with lower levels of anger (r=-.29, p=.00). Among the variables studied, dissatisfaction with access to the service (β=-.172, p=.00), with the healthcare staff (β=-.121, p=.01), and perceived severity of the child's health status (β=.157, p=.00) predicted higher levels of anger.

CONCLUSIONS

On the basis of our results, it is important to continue working to substantially improve access for patients and their families to the emergency department, as well as the information and communication process with the healthcare staff should be included in intervention initiatives.

Patient- and family-centered care coordination: a framework for integrating care for children and youth across multiple systems

Understanding a care coordination framework, its functions, and its effects on children and families is critical for patients and families themselves, as well as for pediatricians, pediatric medical subspecialists/surgical specialists, and anyone providing services to children and families. Care coordination is an essential element of a transformed American health care delivery system that emphasizes optimal quality and cost outcomes, addresses family-centered care, and calls for partnership across various settings and communities. High-quality, cost-effective health care requires that the delivery system include elements for the provision of services supporting the coordination of care across settings and professionals. This requirement of supporting coordination of care is generally true for health systems providing care for all children and youth but especially for those with special health care needs. At the foundation of an efficient and effective system of care delivery is the patient-/family-centered medical home. From its inception, the medical home has had care coordination as a core element. In general, optimal outcomes for children and youth, especially those with special health care needs, require interfacing among multiple care systems and individuals, including the following: medical, social, and behavioral professionals; the educational system; payers; medical equipment providers; home care agencies; advocacy groups; needed supportive therapies/services; and families. Coordination of care across settings permits an integration of services that is centered on the comprehensive needs of the patient and family, leading to decreased health care costs, reduction in fragmented care, and improvement in the patient/family experience of care.

Paediatric spinal fusion surgery and the transition to home-based care: provider expectations and carer experiences

There are more than 12 million children with special healthcare needs (CSHCNs) in the United States, many of whom require specialised health-care to treat chronic physical and developmental conditions. This study is a qualitative investigation of programme, surgical and at-home recovery experiences among CSHCNs and their family carers who participated in a spine surgical care programme at a paediatric hospital in the Western United States. The programme is designed to manage increased surgical risk and the transition of care from hospital to home for children with severe scoliosis undergoing spinal fusion surgery. We conducted 30 semi-structured in-depth interviews with 14 surgical team members and 16 family carers of children who had programme evaluations and spinal surgeries in 2006. Data were collected in 2008 and 2009 in hospital or at home locations to gather programme participation feedback from families and inform the adequacy of programme support to families during at-home recovery. Data were analysed by reflexive team and content analysis methodologies. Results showed the programme was effective at improving preoperative surgical evaluation and helping families to anticipate some aspects of the surgical experience and hospital discharge. However, the impact of spinal fusion surgery and the subsequent transition to home-based care was profoundly emotional for patients and their carers. Our data indicate that programme providers underestimated the extent of emotional trauma experienced by patients and families, particularly during the at-home recovery process. The data also suggest meaningful differences in providers' and carers' expectations for surgery. Carers' disappointment with their recovery experiences and the perceived lack of post-discharge support impacted their interpretations of and perspectives on their surgical experience. Implications of this research for surgical care programmes include the need for assessment and provision of support for physical, social, and emotional burdens experienced by patients and carers at pre-surgical, surgical and at-home recovery phases.

Parental stress and satisfaction during children's hospitalization: differences between immigrant and autochthonous population

This study explored the relation between parents' stress and satisfaction during children's hospitalization, seeking possible differences between immigrant and autochthonous population and also as a function of gender in a sample of parents of hospitalized children in Andalusia, Spain. A total of 1347 parents participated in this study. Of the sample, 50% were immigrants and the other 50% were autochthonous. The assessment instruments were the Hospitalization Stress Scale and the Satisfaction with Hospitalization Scale. The results show that stress was associated with the manifestations of the child's illness, the alteration of family life or of parental roles during the process and some aspects of the clinical staff's work. General satisfaction in immigrant parents was higher than in the autochthonous population and the levels of satisfaction were higher in men than in women. Small changes and initiatives in relation to care could substantially improve the satisfaction of patients and their relatives during the process of hospitalization.

Perceived effectiveness and barriers to physical therapy services for families and children with Friedreich ataxia

PURPOSE

To describe the frequency, type, and perceived effectiveness of physical therapy interventions for children with Friedreich ataxia (FA); identify barriers to therapy; and solicit advice from parents.

METHOD

Parents of 30 children with FA participated in semistructured interviews. Qualitative and quantitative methods were used to analyze the data.

RESULTS

Sixty-seven percent of children received direct physical therapy service. Stretching and strengthening exercises were used most frequently, and their perceived usefulness increased as the children aged. Seventy-three percent received home exercise programs; 9% implemented these consistently. External barriers included a lack of expert providers and limited reimbursement. Internal barriers included limited time and energy, lack of awareness of services, and children's preferences not to be treated differently. Parents advised therapists to become experts, advocates, and use approaches based on family and child preferences.

CONCLUSIONS

Outcomes provide a starting point for developing further research, education, and effective interventions for children with FA.

Does the patient-centred medical home work? A critical synthesis of research on patient-centred medical homes and patient-related outcomes

Health-care systems in the USA and most of western Europe face challenges in the coordination and integration of care for patients, particularly those with chronic conditions. In response to these problems, interest in the patient-centred medical home (PCMH) model has increased significantly in recent years in the USA, with PCMH implementation underway in a wide variety of practice settings across the country. Despite this enthusiasm, there have been relatively few attempts to examine the empirical evidence on the effects of PCMH on quality and access-related outcomes for patients. This article reviews findings from empirical evaluations of the effects of PCMH on patient-related outcomes and critically examines methodological and conceptual issues in the growing body of PCMH literature. The results of this review suggest that published evaluations are predominantly weighted towards findings that indicate that PCMH is associated with a wide range of positive patient outcomes. However, methodological and measurement issues present in much of this research should be considered when evaluating these findings. The article concludes with recommendations for future PCMH evaluation.

An assessment of satisfaction with ambulatory child psychiatry consultation services to primary care providers by parents of children with emotional and behavioral needs: the massachusetts child psychiatry access project university of massachusetts parent satisfaction study

This study evaluated parents' experience with University of Massachusetts (UMass) Child Psychiatry Access Project (MCPAP), a consultation service to primary care providers (PCP), aimed at improving access to child psychiatry. Parent satisfaction questionnaire was sent to families referred to UMass MCPAP by their PCP, asking about their concerns leading to the referral, the satisfaction from the service provided, adequacy of the follow up plan, and outcome. Seventy-nine percent of parents agreed or strongly agreed that the services provided were offered in a timely manner. Fifty percent agreed or strongly agreed that their child's situation improved following their contact with the services. Sixty-nine percent agreed or strongly agreed that the service met their family's need. The results suggest moderate to high parental satisfaction with MCPAP model, but highlight ongoing challenges in making successful referrals for children's mental health services in the community, following MCPAP recommendations.

Are family-centred principles, functional goal setting and transition planning evident in therapy services for children with cerebral palsy?

BACKGROUND

Family-centred service, functional goal setting and co-ordination of a child's move between programmes are important concepts of rehabilitation services for children with cerebral palsy identified in the literature. We examined whether these three concepts could be objectively identified in programmes providing services to children with cerebral palsy in Alberta, Canada.

METHODS

Programme managers (n= 37) and occupational and physical therapists (n= 54) representing 59 programmes participated in individual 1-h semi-structured interviews. Thirty-nine parents participated in eleven focus groups or two individual interviews. Evidence of family-centred values in mission statements and advisory boards was evaluated. Therapists were asked to identify three concepts of family-centred service and to complete the Measures of Process of Care for Service Providers. Therapists also identified therapy goals for children based on clinical case scenarios. The goals were coded using the components of the International Classification of Functioning Disability and Health. Programme managers and therapists discussed the processes in their programmes for goal setting and for preparing children and their families for their transition to other programmes. Parents reflected on their experiences with their child's rehabilitation related to family-centredness, goal setting and co-ordination between programmes.

RESULTS

All respondents expressed commitment to the three concepts, but objective indicators of family-centred processes were lacking in many programmes. In most programmes, the processes to implement the three concepts were informal rather than standardized. Both families and therapists reported limited access to general information regarding community supports.

CONCLUSION

Lack of formal processes for delivery of family-centred service, goal-setting and co-ordination between children's programmes may result in inequitable opportunities for families to participate in their children's rehabilitation despite attending the same programme. Standardized programme processes and policies may provide a starting point to ensure that all families have equitable opportunities to participate in their child's rehabilitation programme.

Characteristics of youth in the U.S. receiving services from a Patient-Centered Medical Home (PCMH)

Using data from the 2007 National Survey of Children's Health, this study identifies the characteristics of those youth served and not served by a medical home. Although Patient-Centered Medical Homes (PCMHs) are being piloted with Medicaid clients, these national data indicate that adolescents are least likely to receive services from a medical home as are youth of color, those with family income levels between 0-99% of the Federal poverty level, and those currently uninsured. These populations, as well as children with special health care needs and youth in the child welfare system, however, may be those most likely to benefit from a PCMH.

The impact of medical home on selected children's health outcome

Medical Home practice has been shown to deliver effective health care to children. This practice model calls for providing patient-centered care that is compassionate, culturally effective, coordinated, integrated, safe, of high quality, and accessible. This study shows that children in the states with a higher amount of Medical Home received childhood vaccinations at a higher rate than others. However, Medical Home had a limited effect on the rate of children receiving dental/medical services, mental health services, or number of overweight children.

Primary health care quality in a national sample of children and youth with mental health impairment

OBJECTIVE

To examine the general pediatric health care quality experiences of children and youth with mental health impairment.

METHODS

We conducted a cross-sectional analysis of 2006 Medical Expenditures Panel Survey data for children and youth aged 5 to 17 years (n = 7263). Mental health impairment was defined using the recommended cut-point (score ≥ 16) on the parent version of the Columbia Impairment Scale. Health care quality was measured with the Consumer Assessment of Healthcare Providers and Systems including parent ratings in 3 domains: provider communication, getting needed care, and getting care quickly. Logistic regression was used to test associations between mental health impairment and dichotomized Consumer Assessment of Healthcare Providers and Systems measures (poor vs good quality) adjusted for demographic characteristics, health insurance, and socioeconomic status. Analysis was conducted with Stata, Version 10.1 SE, and all estimates accounted for the Medical Expenditures Panel Survey complex sampling design.

RESULTS

In multivariable analysis, health care experiences of children with mental health impairment (versus those without) were consistently rated less favorably by parents, with greater odds of inferior quality of care ratings in all domains: getting needed care (odds ratio [OR] = 2.35), getting care quickly (OR = 1.41), physician communication (OR = 1.72), and overall health care quality (OR = 1.63).

CONCLUSIONS

Further research is needed to identify specific aspects of care that families find problematic in relation to the organization and delivery of care within each quality domain. Interventions are needed to improve service systems for children and youth with mental health impairment, especially to support access to needed care.

Unmet health care needs among CSHCN with neurologic conditions

OBJECTIVE

Children with neurologic conditions require a variety of services. With this study we examined health care needs and unmet needs among children with neurologic conditions.

METHODS

Cross-sectional data reported by parents of 3- to 17-year-olds in the 2005-2006 National Survey of Children With Special Health Care Needs were analyzed. Demographic characteristics, health care needs, and unmet needs of children with special health care needs (CSHCN) and neurologic conditions were descriptively compared with an independent referent group of children without special health care needs; statistical contrasts were performed as a function of the type (conditions included in the Diagnostic and Statistical Manual of Mental Disorders [DSM] or not) and number of reported neurologic conditions.

RESULTS

Compared with the parents of children without special health care needs, parents of CSHCN with neurologic conditions were more likely to report unmet health care needs for their child. After adjustment for demographic factors and severity of functional limitation, CSHCN with at least 2 conditions had more visits to a health care provider, needed more services, and reported more unmet needs than CSHCN with a single DSM condition. The magnitude of need among CSHCN was greatest among those with at least 1 of each type of neurologic condition.

CONCLUSIONS

Unmet health care needs exist among CSHCN with neurologic conditions and are particularly pronounced among children with a combination of both DSM and non-DSM disorders. The health care needs among CSHCN with multiple neurologic conditions may be better served by targeted efforts to improve care coordination.

The impact of insurance on satisfaction and family-centered care for CSHCN

BACKGROUND

Children with special health care needs (CSHCN) have worse health outcomes and satisfaction compared with children with typical needs. Although individual characteristics influence satisfaction and family-centered care, additional effects of health insurance and state child health policies are unknown.

OBJECTIVES

To determine if satisfaction and family-centered care varied among CSHCN, after adjusting for individual characteristics, according to insurance type and state child health policies.

METHODS

We performed descriptive and multivariate analyses by using demographic, insurance, and satisfaction data from the 2006 National Survey of Children With Special Health Care Needs (N = 40723). Additional state data included Medicaid and State Children's Health Insurance Program (SCHIP) characteristics and the supply of pediatricians. We supplemented the national findings with survey data from Florida's SCHIP comprehensive care program (CMS-Duval ["Ped-I-Care"]) for CSHCN (N = 300).

RESULTS

Nationally, 59.8% of parents were satisfied with their child's health services, and two thirds (65.7%) received family-centered care. Adjusting for individual predictors, those uninsured and those with public insurance were less satisfied (odds ratios [ORs]: 0.45 and 0.83, respectively) and received less family-centered care (ORs: 0.43 and 0.80, respectively) than privately insured children. Of note, satisfaction increased with state Medicaid spending. Survey data from Ped-I-Care yielded significantly higher satisfaction (91.7%) compared with national levels of satisfaction in the SCHIP (54.2%) and similar rates of family-centered care (65.6%). These results suggest that satisfaction is based more on experiences with health systems, whereas family-centered care reflects more on provider encounters.

CONCLUSIONS

Insurance type affects both satisfaction and family-centered care for CSHCN, and certain state-level health care characteristics affect satisfaction. Future studies should focus on interventions in the health care system to improve satisfaction and patient encounters for family-centered care.

A longitudinal study of a pediatric practice-based versus an agency-based model of care coordination for children and youth with special health care needs

BACKGROUND

Care coordination has been shown to improve the quality of care for children and youth with special health care needs (CYSHCN). However, there are different models for structuring care coordination in relation to the medical home and most Title V agencies use an agency-based model of care coordination. No studies have prospectively compared a practice-based care coordination model to a Title V agency-based care coordination model.

OBJECTIVE

Report the results of a prospective cohort study comparing a practice-based nurse care coordinator model with Title V agency-based care coordination model.

DESIGN/METHODS

Three pediatric practices received the intervention, placement of a nurse care coordinator onsite within the practice, along with training and quality improvement on the principles of the medical home. Three practices continued to rely on agency-based care coordination services. CYSHCN in the practices were identified, interviewed at baseline, and re-interviewed after 18 months. We interviewed 262 families/children at baseline and 144 families/children (76 in the intervention and 68 in the comparison group) at 18 months. Families rated the quality of services they received from the care coordinator and the pediatric practice, and their experience of barriers to services for their CYSHCN.

RESULTS

Families in the practice-based care coordination group were more likely to report improvement in their experience with the care coordinator (P = 0.02), fewer barriers to needed services (P = 0.003), higher overall satisfaction with care coordination (P = 0.03), and better treatment by office staff (P = 0.04).

CONCLUSIONS

We found that for families of CYSHCN, practice-based care coordination in the medical home led to increased satisfaction with the quality of care they received and a reduction of barriers to care. The practice-based care coordination model is utilized by a minority of State Title V agencies and should be considered as a potentially more effective model than the agency-based approach.